Adolescent Diabetes Treatment and Development

More than likely, you have just breezed through the latency period of your school-aged child. Welcome to the new world of major changes: physical transformations, emotional lability, cognitive growth, and confusion for both caregivers and child. Most likely, just a short time ago, your child was chatting about sports, extracurricular activities, and reporting blood sugars. Now, he is in his room with the door shut. "What have I done" you think. The answer is nothing. The onset of puberty and the surge of hormones are responsible. Life changes significantly for teens as they enter adolescence. We, as parents and caregivers, though we may secretly wish to turn back the clock, must let our children pass through this turbulent stage of development to reach adulthood.

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I would like to compare this chaotic stage of development to another earlier rite of passage. If you have journeyed with your child thus far, you will remember the terrible twos. Many of the developmental tasks of this period resemble those of adolescence. Issues such as emerging independence (confidently walking away and then immediately looking back), defiance (NO, NO, NO) and increased physical and cognitive abilities (improved fine and gross motor skills, language) are nearly identical in your adolescent. The stakes are higher, of course. Walking away becomes driving and defiance takes on an ominous tone. The simple timeout will not be an effective means of discipline. However, a variation of the timeout will often work! The techniques of limit setting will once again come into play.

Another important driving factor in the social development of our adolescent children is the need to fit in with peers. This need to identify with the peer group is often the biggest factor responsible for undermining diabetes self-care related issues. Our teens simply want to be like everyone else. Unfortunately, they are not. We, therefore, must be cognizant of this underlying current of peer identity as we work with our teens in an effort to control blood sugars. Other physical factors come into play that makes it difficult for the teen to manage diabetes. Hormone surges may cause insulin resistance and more variability of blood sugars, which your teen cannot control. The adolescent also can't control the adrenalin surge when they are in the midst of a lacrosse game and his/her blood sugars shoot up. All high blood sugars do not mean that your teen is abrogating his healthcare responsibilities. The important issue is to remember what he/she can or cannot control.

Another major factor to remember is that despite impressive gains in problem solving (especially related to school) these intellectual capacities may not translate into improved diabetes self-care behaviors. Hence, it is essential that diabetes-related tasks be the responsibility of both the teen and adult caregivers. Many parents believe that once the child appears to be independent in terms of staying home alone safely and driving that they no longer need to be closely involved with diabetes management. This is NOT true! Stay involved with your "kidult" and delegate responsibilities with appropriate follow-up. Limit-setting is important--it is not ok for them to act irresponsibly in non-diabetes situations (drinking; etc), nor is it ok for them to ignore diabetes related chores. Negotiation with your adolescent is key. I recommend the divide and conquer method... and holding your child accountable.

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Beware of manipulation by your child. Fabricating blood sugars, pretending to give insulin injections, dietary indiscretions, etc. are examples. Know that many teens will try this destructive behavior at least once. When this behavior is revealed in the diabetes visit, misery usually follows for both parent and teen. They feel bad because they are caught and they really do care about their health. Unsuccessful attempts by well-meaning caregivers to point out the risk of future complications lead to more resistance from the teen. They usually do not want to hear what may happen to them when they are 30, but what will happen now. Use this strategy to your advantage and set limits. "No learner's permit until you test before driving and at least four times per day." "No staying overnight at a friend's house until you demonstrate appropriate insulin administration." Use positive reinforcement for desired behaviors, such as purchasing "itunes" for testing appropriately, "retail therapy" for improved record keeping, etc. One prominent child psychologist that specializes in diabetes came up with an excellent strategy that I have started to test out in practice. I ask how much time it takes to perform diabetes-related tasks in a day. Most teens will say about 30 minutes to one hour. I then inquire about the amount of time that is spent with the caregiver nagging about performing self-care skills. The answer is usually 23 hours! Most teens will at least think about performing 30 to 60 minutes of work to avoid relentless nagging.

In review

Suggested strategies in working with your adolescent:

Be involved

Remain involved

Negotiate contracts

Set limits (and follow-through)

Observe diabetes related behavior...closely

Avoid manipulation by your smart teen

Be aware that not all high blood sugars are caused by dietary indiscretions or insulin omission